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<title>Cat Blue Sheet</title>
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<body>
<div id="bodywidth">
<? include("header.inc");
include("leftmenu.inc");  ?>
<div id="wide2column">
<div class="bluebkgrnd">
<?php
include("db.php");
// Connect to the database server
dbConnect('kar_web1');   	// Use function in db.php to connect
$breeds = @mysql_query("SELECT * FROM petfinderBreeds
						WHERE animalType=' Dog '
						ORDER BY breedID");
if (!$breeds) {
	echo("<p>Error performing query: " . mysql_error() . "</p>");
	exit();
}  // end if 
//   Loop through and write long Option_Block string containing database data
$option_block = "<OPTION value=\"none\" SELECTED>none</OPTION>";
while ($row = mysql_fetch_array($breeds)) {
	$name  = $row["breedName"];
	$option_block .= "<OPTION value=\"$name\">$name</OPTION>";
}  // end while
?>
 <CENTER><H2>Dog Blue Sheet</H2>
 </CENTER><BR CLEAR=ALL>
<CENTER>
<TABLE WIDTH=550>
<TR>
  <TD>
Foster homes: Please fill out this form to give us information about the <B>dog/puppy(s)</B> you are fostering for Kalamazoo Animal Rescue. Use the TAB key or your mouse to move between fields. Some browsers will send the form before you are done if you hit ENTER.</TD>
</TR>
<TR><TD>
</TABLE></CENTER>

<form action="submit_dogblue.php" method="post" name="form1" id="form1" onsubmit="return validateForm();">
<INPUT TYPE="hidden" NAME="success" VALUE="thanks4.htm">

<STRONG>Your Name:</STRONG> <BR><INPUT NAME="v_name" TYPE=TEXT id="v_name" SIZE=50>
<BR><BR>

<STRONG>Home Phone:</STRONG><BR>
<INPUT NAME="home_phone" TYPE=TEXT id="home_phone" SIZE=15>
<BR><BR>
<STRONG>Your Email Address:</STRONG>&nbsp;&nbsp;<FONT COLOR=#ff0000 SIZE="-1">(username@host.com)</FONT><BR><INPUT NAME="email" TYPE=TEXT id="email" SIZE=50>
<BR><BR>
<STRONG>Is this a new foster animal or an update?</STRONG><BR>
<INPUT TYPE="radio" NAME="status" VALUE="NEW PET">New
<INPUT TYPE="radio" NAME="status" VALUE="UPDATE">Update
<INPUT TYPE="radio" NAME="status" VALUE="TRANSFER">Transfer
<INPUT TYPE="radio" NAME="status" VALUE="SIDELINE">Sideline
<BR><BR>
<STRONG>If update, state reason or item changed. If transfer, list previous foster volunteer and<BR>
animal names. If sideline, list reason or name of potential adopter.</STRONG><BR>
<INPUT NAME="previous" TYPE=TEXT id="previous" SIZE=40>
<BR>
<BR>
<STRONG>Dog's Name:</STRONG> <BR><INPUT NAME="d_name" TYPE=TEXT id="d_name" SIZE=50>
<BR>
<BR>
<STRONG>Pet has been Microchipped</STRONG> &nbsp;&nbsp;&nbsp;&nbsp;<BR>
<INPUT TYPE="radio" NAME="microchipped" VALUE="Yes">    Yes
<INPUT TYPE="radio" NAME="microchipped" CHECKED VALUE="No">    No<BR><BR>
<STRONG>Microchip Brand</STRONG><BR><input name="microchipBrand" type="text" id="microchipBrand"  size=30>
<br /><BR></p>
<STRONG>Microchip ID</STRONG><BR><input name="microchipID" type="text" id="microchipID"  size=30 >
<br />
<BR>
<STRONG>Primary Breed:</STRONG> <BR><!-- <INPUT TYPE=TEXT NAME="p_breed" SIZE=50> -->
<SELECT  name="p_breed">
<? echo "$option_block"; ?>
</SELECT>
<BR><BR>
<STRONG>Secondary Breed:</STRONG> <BR><!-- <INPUT TYPE=TEXT NAME="s_breed" SIZE=50> -->
<SELECT  name="s_breed">
<? echo "$option_block"; ?>
</SELECT>
<BR><BR>
<STRONG>Mixed Breed?</STRONG><BR>
<INPUT TYPE="radio" NAME="mixed" VALUE="Yes">Yes
<INPUT TYPE="radio" NAME="mixed" VALUE="No">No<BR><BR>
<STRONG>Gender:</STRONG><BR>
<INPUT TYPE="radio" NAME="sex" VALUE="Male">Male
<INPUT TYPE="radio" NAME="sex" VALUE="Female">Female<BR><BR>
<STRONG>Size when Grown (lbs):</STRONG><BR>
<INPUT TYPE="radio" NAME="size" VALUE="Small">
Small (Up to 25)
<INPUT TYPE="radio" NAME="size" VALUE="Medium">
Medium (26-60)
<INPUT TYPE="radio" NAME="size" VALUE="Large">
Large (61-100)
<INPUT TYPE="radio" NAME="size" VALUE="Extra_Large">
Extra Large (Over 100)<BR>
<BR>
<STRONG>Approximate Date of Birth:</STRONG>&nbsp;&nbsp;<select NAME="DOB_month">
<option VALUE="01" <?php if (date(m)=='01') echo("SELECTED");?>>Jan
<option VALUE="02" <?php if (date(m)=='02') echo("SELECTED");?>>Feb
<option VALUE="03" <?php if (date(m)=='03') echo("SELECTED");?>>Mar
<option VALUE="04" <?php if (date(m)=='04') echo("SELECTED");?>>Apr
<option VALUE="05" <?php if (date(m)=='05') echo("SELECTED");?>>May
<option VALUE="06" <?php if (date(m)=='06') echo("SELECTED");?>>Jun
<option VALUE="07" <?php if (date(m)=='07') echo("SELECTED");?>>Jul
<option VALUE="08" <?php if (date(m)=='08') echo("SELECTED");?>>Aug
<option VALUE="09" <?php if (date(m)=='09') echo("SELECTED");?>>Sep
<option VALUE="10" <?php if (date(m)=='10') echo("SELECTED");?>>Oct
<option VALUE="11" <?php if (date(m)=='11') echo("SELECTED");?>>Nov
<option VALUE="12" <?php if (date(m)=='12') echo("SELECTED");?>>Dec
</select>&nbsp;&nbsp;
<select NAME="DOB_day">
<option VALUE="01" <?php if (date(d)=='01') echo("SELECTED");?>>1
<option VALUE="02" <?php if (date(d)=='02') echo("SELECTED");?>>2
<option VALUE="03" <?php if (date(d)=='03') echo("SELECTED");?>>3
<option VALUE="04" <?php if (date(d)=='04') echo("SELECTED");?>>4
<option VALUE="05" <?php if (date(d)=='05') echo("SELECTED");?>>5
<option VALUE="06" <?php if (date(d)=='06') echo("SELECTED");?>>6
<option VALUE="07" <?php if (date(d)=='07') echo("SELECTED");?>>7
<option VALUE="08" <?php if (date(d)=='08') echo("SELECTED");?>>8
<option VALUE="09" <?php if (date(d)=='09') echo("SELECTED");?>>9
<option VALUE="10" <?php if (date(d)=='10') echo("SELECTED");?>>10
<option VALUE="11" <?php if (date(d)=='11') echo("SELECTED");?>>11
<option VALUE="12" <?php if (date(d)=='12') echo("SELECTED");?>>12
<option VALUE="13" <?php if (date(d)=='13') echo("SELECTED");?>>13
<option VALUE="14" <?php if (date(d)=='14') echo("SELECTED");?>>14
<option VALUE="15" <?php if (date(d)=='15') echo("SELECTED");?>>15
<option VALUE="16" <?php if (date(d)=='16') echo("SELECTED");?>>16
<option VALUE="17" <?php if (date(d)=='17') echo("SELECTED");?>>17
<option VALUE="18" <?php if (date(d)=='18') echo("SELECTED");?>>18
<option VALUE="19" <?php if (date(d)=='19') echo("SELECTED");?>>19
<option VALUE="20" <?php if (date(d)=='20') echo("SELECTED");?>>20
<option VALUE="21" <?php if (date(d)=='21') echo("SELECTED");?>>21
<option VALUE="22" <?php if (date(d)=='22') echo("SELECTED");?>>22
<option VALUE="23" <?php if (date(d)=='23') echo("SELECTED");?>>23
<option VALUE="24" <?php if (date(d)=='24') echo("SELECTED");?>>24
<option VALUE="25" <?php if (date(d)=='25') echo("SELECTED");?>>25
<option VALUE="26" <?php if (date(d)=='26') echo("SELECTED");?>>26
<option VALUE="27" <?php if (date(d)=='27') echo("SELECTED");?>>27
<option VALUE="28" <?php if (date(d)=='28') echo("SELECTED");?>>28
<option VALUE="29" <?php if (date(d)=='29') echo("SELECTED");?>>29
<option VALUE="30" <?php if (date(d)=='30') echo("SELECTED");?>>30
<option VALUE="31" <?php if (date(d)=='31') echo("SELECTED");?>>31
</select>&nbsp;&nbsp;
<select NAME="DOB_year">
<option value="2011" <?php if (date(Y)=='2011') echo("SELECTED");?>>2011
<option value="2010" <?php if (date(Y)=='2010') echo("SELECTED");?>>2010
<option value="2009" <?php if (date(Y)=='2009') echo("SELECTED");?>>2009
<option value="2008" <?php if (date(Y)=='2008') echo("SELECTED");?>>2008
<option value="2007" <?php if (date(Y)=='2007') echo("SELECTED");?>>2007
<option value="2006" <?php if (date(Y)=='2006') echo("SELECTED");?>>2006
<option value="2005" <?php if (date(Y)=='2005') echo("SELECTED");?>>2005
<option value="2004">2004
<option value="2003">2003
<option value="2002">2002
<option value="2001">2001
<option value="2000">2000
<option value="1999">1999
<option value="1998">1998
<option value="1997">1997
<option value="1996">1996
<option value="1995">1995
<option value="1994">1994
<option value="1993">1993
<option value="1992">1992
<option value="1991">1991
<option value="1990">1990
<option value="1989">1989
<option value="1988">1988
<option value="1987">1987
</select><BR><BR>
<STRONG>Color(s):</STRONG> <BR><INPUT NAME="color" TYPE=TEXT id="color" SIZE=50>
<BR><BR>
<STRONG>Housebroken:</STRONG><BR>
<INPUT TYPE="radio" NAME="house_broke" VALUE="Yes">Yes
<INPUT TYPE="radio" NAME="house_broke" VALUE="No">No<BR><BR>
<STRONG>Spayed/Neutered:</STRONG><BR>
<INPUT TYPE="radio" NAME="altered" VALUE="Yes">Yes
<INPUT TYPE="radio" NAME="altered" VALUE="No">No
<BR><BR>
<STRONG>Up To date on Shots:</STRONG><BR>
<INPUT TYPE="radio" NAME="shots" VALUE="Yes">Yes
<INPUT TYPE="radio" NAME="shots" VALUE="No">No
<BR><BR>
<STRONG>Pet has been vaccinated for Rabies</STRONG> &nbsp;&nbsp;&nbsp;&nbsp;<BR>
<INPUT TYPE="radio" NAME="rabies" VALUE="Yes">Yes
<INPUT TYPE="radio" NAME="rabies" CHECKED VALUE="No">No
<BR><BR>
<STRONG>How did the Animal Come into the Rescue?</STRONG><BR>
<INPUT TYPE="radio" NAME="inroad" VALUE="Stray">Stray
<INPUT TYPE="radio" NAME="inroad" VALUE="Owner_Relinquish">Owner Relinquish
<INPUT TYPE="radio" NAME="inroad" VALUE="Animal_Services">Animal Services 
<input type="radio" name="inroad" value="born_in_KAR" />Born in KAR
<INPUT TYPE="radio" NAME="inroad" VALUE="Other">Other<BR><BR>
<STRONG>Special Needs</STRONG>: <BR>
<TEXTAREA NAME="spec_needs" COLS=58 ROWS=3 wrap=physical id="spec_needs"></TEXTAREA>
<BR><BR>
<STRONG>Placement - Dog requires a fence?</STRONG><BR>
<INPUT TYPE="radio" NAME="fence" VALUE="Yes">Yes
<INPUT NAME="fence" TYPE="radio" VALUE="No" checked="checked">No
<BR><BR>
<STRONG>Placement - Home without other dogs?</STRONG><BR>
<INPUT TYPE="radio" NAME="otherdogs" VALUE="Yes">Yes
<INPUT NAME="otherdogs" TYPE="radio" VALUE="No" checked="checked">No
<BR><BR>
<STRONG>Placement - Home without cats?</STRONG><BR>
<INPUT TYPE="radio" NAME="cats" VALUE="Yes">Yes
<INPUT NAME="cats" TYPE="radio" VALUE="No" checked="checked">No
<BR><BR>
<STRONG>Placement - Home without small children (&lt;5 yrs)?</STRONG><BR>
<INPUT TYPE="radio" NAME="kids" VALUE="Yes">Yes
<INPUT NAME="kids" TYPE="radio" VALUE="No" checked="checked">No
<BR><BR>
<STRONG>Bio for Petfinder:</STRONG><BR>
<textarea name="bio" cols=58 rows=8 wrap=physical id="bio"></textarea>
<INPUT NAME="ip" type="hidden" value="<?PHP echo $_SERVER['REMOTE_ADDR']; ?>" />
<INPUT TYPE=SUBMIT VALUE="Submit Info">
</FORM>
<BR>
</div>
</div>
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